von Olshausen Gesa, Benson Lina, Dahlström Ulf, Lund Lars H, Savarese Gianluigi, Braunschweig Frieder
Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
Eur J Heart Fail. 2022 Sep;24(9):1636-1646. doi: 10.1002/ejhf.2604. Epub 2022 Jul 20.
To investigate the association between catheter ablation for atrial fibrillation (AF) and mortality as well as hospitalization for heart failure (HF) in patients with HF across the ejection fraction (EF) spectrum.
Patients with first-time catheter ablation for AF (ablation group) compared to only medical treated AF patients (no ablation group) were identified from the Swedish Heart Failure Registry between 2005 and 2019. The primary outcome (all-cause mortality/first HF hospitalization) was assessed by Cox regression models in a 1:2 propensity score (PS) matched cohort and pre-specified EF subgroups (preserved EF [≥50%], mildly reduced EF [40-49%], reduced EF [<40%]) of this cohort. A total of 452 patients in the ablation group and 43 766 patients in the no ablation group were identified. After PS matching, 434 patients in the ablation group were compared to 868 patients in the no ablation group. Over a median follow-up of 2.6 years (0.0-14.1 years), catheter ablation was associated with a lower risk of the primary outcome (all-cause mortality/first HF hospitalization) (hazard ratio [HR] 0.78, 95% confidence interval [CI] 0.65-0.94). Results were consistent across all EF subgroups. In HF with preserved EF (HFpEF), catheter ablation was also associated with a lower risk of recurrent HF hospitalization (incidence rate ratio 0.17, 95% CI 0.07-0.42).
In HF patients across the EF spectrum, catheter ablation for AF was associated with lower risk of the primary outcome (all-cause mortality/first HF hospitalization). This study supports catheter ablation as a treatment option for AF in HF patients, including those with HFpEF.
研究射血分数（EF）范围内心力衰竭（HF）患者房颤（AF）导管消融与死亡率以及心力衰竭住院之间的关联。
从瑞典心力衰竭登记处识别出2005年至2019年间首次接受AF导管消融的患者（消融组），并与仅接受药物治疗的AF患者（非消融组）进行比较。通过Cox回归模型在1:2倾向评分（PS）匹配队列以及该队列预先指定的EF亚组（保留EF[≥50%]、轻度降低EF[40-49%]、降低EF[<40%]）中评估主要结局（全因死亡率/首次HF住院）。消融组共识别出452例患者，非消融组共识别出43766例患者。PS匹配后，将消融组的434例患者与非消融组的868例患者进行比较。在中位随访2.6年（0.0-14.1年）期间，导管消融与主要结局（全因死亡率/首次HF住院）风险较低相关（风险比[HR]0.78，95%置信区间[CI]0.65-0.94）。所有EF亚组的结果均一致。在保留EF的HF（HFpEF）中，导管消融还与复发性HF住院风险较低相关（发病率比0.17，95%CI 0.07-0.42）。
在整个EF范围内的HF患者中，AF导管消融与主要结局（全因死亡率/首次HF住院）风险较低相关。本研究支持将导管消融作为HF患者AF的一种治疗选择，包括HFpEF患者。
